Provider Demographics
NPI:1750370722
Name:MAYNE, MARILYN ADRIANNE (DO)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:ADRIANNE
Last Name:MAYNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-0780
Mailing Address - Country:US
Mailing Address - Phone:352-589-6005
Mailing Address - Fax:352-589-6012
Practice Address - Street 1:2 N EUSTIS ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3408
Practice Address - Country:US
Practice Address - Phone:352-589-6005
Practice Address - Fax:352-589-6012
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10718207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology